改良式可摘夹板对牙周病松动牙固定的临床病例报告
发布时间：2018-04-05 14:18
本文选题：牙周炎 切入点：牙齿松动度 出处：《大连医科大学》2016年硕士论文
【摘要】：目的:牙周炎患者牙周支持组织受损,患牙受力后产生移位、松动;经牙周基础治疗、调鄈以及牙周手术后,牙齿的松动度会有所减轻,若患牙的松动度仍为患者所不能接受,则需行牙周夹板进行固定。本文选择改良式铸造可摘牙周夹板进行松牙固定,最后对固定疗效进行分析,为可摘牙周夹板的临床应用提供依据。方法:选择2014年3月到2016年1月于我院就诊的10例牙周炎患者。病例纳入标准:1、牙周炎确诊,伴有或不伴有牙列缺损;2、患者拒绝拔牙或身体状况不允许拔牙或拒绝大量磨牙;3、已行完善的牙周基础治疗及手术治疗,炎症得到有效控制,但患者对咀嚼功能仍不满意;4、有牙髓症状或牙周牙髓联合病变者已行完善的牙髓治疗;5、患者同意行可摘牙周夹板修复,能够在美学上接受可见的金属支架;6、术后能保持良好的口腔卫生。检查口腔内情况并拍X线片全面评定牙周及牙髓病变程度;拔除无保留价值的Ⅲ°松动牙,若患者不愿意拔除或者身体状况不允许拔除,可行姑息治疗,将该牙在夹板上所对应的舌板做成网状,便于日后增添树脂牙;对有龋坏及牙体缺损的患牙行牙体充填;对于有牙髓症状或者牙周牙髓联合病变者行完善的RCT治疗;口腔卫生宣传教育,超声龈上洁治、龈下刮治、根面平整、局部涂药。6—8周后复诊检查口内菌斑、牙石控制情况,牙周袋探诊深度,牙齿松动度等。炎症得到控制后,进行必要的咬合调整,建立平衡的咬合关系。若经基础治疗后口腔卫生良好,但牙周袋仍≥5mm,探诊后有出血或溢脓者;后牙的根分叉病变达Ⅱ°或Ⅲ°,需手术暴露根分叉者,应行手术治疗。待牙周情况稳定后,行改良式铸造可摘夹板固定患牙。选择无松动或者Ⅰ°松动牙做固位基牙,固位基牙尽量分散;设计长臂卡、联合卡固定松动牙,义齿舌侧设计为舌板,与健康邻牙上的鄈支托连用时对余留松动牙具有明显的固定作用。固位基牙颊侧固位臂位于导线之下,余牙卡环均在导线之上,仅起支持和稳定作用,无固位力;对于Ⅱ°-Ⅲ°松动以及经根管治疗后的患牙我们改良设计了大“鄈支托”,其面积为鄈面的1/2-2/3,“鄈支托”与对颌牙只形成尖窝接触,而该大“鄈支托”只行使窝的功能,患牙的功能尖不与对颌接触,减轻了患牙所受鄈力,防止患牙劈裂,如果日后患牙脱落,可以直接增添树脂义齿,存在的大“鄈支托”可以有效的将鄈力分散至大连接体上,进而传至牙周支持组织;设计改良式联合卡,其固位基牙侧的卡环臂位于导线之下,起固位作用,而松动患牙侧的卡环臂位于导线之上,只起卡抱作用,若固位基牙的同一侧有两个松动患牙,可将该侧卡环臂设计成长臂卡环,即联合卡与长臂卡的结合体;基托伸展范围和局部可摘义齿基本相同,基托与牙接触区应位于牙冠外形高点线处并接触密合,在龈乳突处的基托组织面则要有足够的缓冲。预备鄈支托窝、隙卡沟(尽量利用自然间隙)以及舌侧导平面,制备共同就位道;取印模前可将Ⅲ°松动牙通过树脂粘接剂与邻牙固定到一起,以防止印模材的挤压造成其移位;取印模后送义齿加工厂制作可摘夹板,一并修复缺失牙。嘱患者半年、1年、2年定期复查,复查时对患者进行诊断性监测,强化与患者的沟通和菌斑控制,辅以口腔卫生指导,行全口的洁治及相应的治疗。结果:评价标准:从患者的主观感觉、口腔临床检查以及X线检查三个方面进行评价。经过一年到两年复诊,行改良式可摘牙周夹板修复的10例患者均表示疼痛消失,咀嚼功能恢复良好,松动牙得到固定;临床检查牙周袋变浅,无溢脓,患牙松动减轻或无进一步发展;X线片示牙槽骨新生或无进一步吸收。结论:改良式铸造可摘夹板对牙周病松动牙固定效果显著,我们改良设计的大“鄈支托”以及联合卡尤其适用于经根管治疗的患牙以及重度松动患牙,可以有效防止牙劈裂及牙脱落,更好的恢复患者的咀嚼功能,并可同时修复牙列缺损,消除食物嵌塞;又由于其操作简单,费用较低,在临床上得到广泛应用。
[Abstract]:Objective: periodontal support tissue damage, the tooth force resulting from displacement, loosening; after periodontal treatment, adjusting Kui and periodontal surgery, loose teeth will be reduced, if the acceptance of tooth mobility is not required for patients, periodontal splint for fixing. This paper chooses improved casting of loose teeth fixed removable periodontal splint fixation, finally the curative effect analysis, provide the basis for clinical application of removable periodontal splint. Methods: 10 cases of periodontitis patients selected from March 2014 to January 2016 in our hospital. The inclusion criteria: 1, diagnosed with or without periodontitis. Dentition defect; 2 patients refused extraction or physical condition does not allow extraction or refusal of a large number of 3 molar; has basic treatment and periodontal treatment to improve the inflammation has been effectively controlled, but the patients on the masticatory function is still not satisfied; 4, there are symptoms or dental pulp The periodontal lesions have been combined with pulp pulp treatment improved; 5 patients agreed for removable periodontal splint, can accept metal stents visible in aesthetics; 6, after surgery can maintain good oral hygiene and oral examination. X-ray comprehensive assessment of periodontal and dental pulp disease degree; pull out without reservation value of third degree loose teeth, if patients are not willing to pull out or physical condition does not allow removal of palliative treatment, the tongue plate of the teeth in the splint made of mesh, easy to add after resin teeth on the affected teeth; dental filling with caries and tooth defect; for RCT treatment of dental pulp disease or periodontal endodontic lesions for improvement; oral hygiene education, ultrasonic supragingival scaling, subgingival scaling and root planing, topical drug.6 8 Zhou Houfu examination in plaque, tartar control, periodontal probing depth, loose teeth Degree. The inflammation was controlled after occlusal adjustment is necessary, the establishment of occlusal balance. If the basic treatment of oral health is good, but the periodontal pocket is still more than 5mm, after the detection of bleeding or pus overflow; the molar furcation involvement of second degree or third degree, requiring surgical exposure of the furcation. Should undergo surgical treatment. For periodontal stability, for improved casting removable splint teeth. No loosening or 1 degree tooth solid abutments, solid abutments to disperse; design of arm joint card card, fixation of loose teeth, denture design for lingual tongue plate, and Kui a healthy dentition on support for the remaining loose teeth with fixed effect. Solid abutments buccal retentive arm wire positioned under the remaining tooth ring card in the wire, only support and stability, no retention; for the second degree and third degree - Loosening after root canal after treatment, the teeth we changed 鑹璁′簡澶р，
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